The Relationship Between Depression and Sleep Disorders

Not all people who suffer from depression have sleep disorders, however many do. Doctors, when trying to diagnose patients for depression, typically ask about their sleep patterns. Classic symptoms of clinical depression are trouble sleeping, insomnia and oversleeping. Sleep problems usually affect mood as well, causing depression, creating a vicious cycle.

What Are the Symptoms of Depression?

According to the CDC, just over 7 percent of Americans suffer from moderate to severe depression. Although the severity of these will vary, the most common symptoms of depression are:

  • Feelings of hopelessness, sadness and despair.
  • Lower energy
  • Reduced libido
  • Reduced self-esteem
  • Difficulty concentrating
  • Thoughts of suicide, occasional or frequent
  • Weight loss or weight gain
  • Insomnia
  • Excessive daytime sleepiness
  • Loss of interest in activities that the person once enjoyed

Reading this you realize that sleep problems are core symptoms of depression.The symptoms of depression are persistent and pervade all aspects of an individual’s’ life from work and play to basic needs like eating and sleeping.

People who suffer from depression have trouble being productive in work or school, as depression impacts their career and social life. Health problems like heart disease, smoking and mental disorders are major risk factors in those who have depression and severe sleep problems. Sleep issues are also one of the reasons people seek out professional help.

There are several different types of depression which come with their own type of sleep problems.

  • Bipolar Disorder: People with bipolar disorder swing between extreme highs and lows. When they’re high, they’re overly energetic and unable to sleep, even if they’re tired. When they’re low, they oversleep.
  • Major Depressive Disorder: This is extreme depression where the individual feels sad, hopeless, or suicidal through much of the day, regardless of what they are doing. Feelings of pleasure and happiness are hard to come by. Major depression is associated with insomnia and excessive daytime sleepiness.
  • Dysthymia:  However, a milder form of major depression, this is also associated with fragmented sleep and hypersomnia. People with dysthymia experience fewer symptoms from the list above and in a less intense way, but symptoms typically persist for much longer.
  • Seasonal Affective Disorder (SAD): SAD is a type of seasonal depression. The vast majority of affected individuals experience it during the winter months, with symptoms like hypersomnia, insomnia, and worsened mood – although about 10% experience it during the summer. SAD is likely brought on by the changing levels of sunlight, which affect the circadian rhythms of affected individuals, messing with their sleep and emotions.

Anyone can become depressed, but it affects some people more than others, particularly women and adults in middle age. Stress, an illness diagnosis and family history are all risk factors for depression. Women and adults are also more likely to suffer from insomnia.

Depression and Sleep Have a Cyclical Relationship

Depression and sleep have a cyclical relationship in that sleep problems brought on by depression, or reversely, the ones that caused it in the first place make it much more difficult to get better. Abnormal sleep interferes with one’s energy level and mood during the day. This makes it harder to stay motivated enough to go to work, exercise and even engage with others.

Also, sleep deprived people have stronger emotional reactions in general, so it’s harder  to regulate the emotional volatility associated with depression. Because of this, people who are depressed tend to self-isolate, leading to more sleep problems. Fragmented sleep is associated with loneliness itself.

The cause-and-effect runs both ways. Lack of sleep increases your chances of depression and other mental illnesses even if you’re not depressed. In addition, depression causes insomnia and hypersomnia.   

Particularly for young adults, there is a strong correlation between insomnia and major depressive disorder. Genes involved in the molecular clock and circadian cycle are known to be involved with bipolar disorder, although nobody exactly knows how.

When scientists examine mice with mutations in the so-called CLOCK gene (important in the circadian cycle), they find the mice act like humans with mania. When the mice are given lithium (a treatment for bipolar disorder), their behavior reverts to normal. So it appears that this important part of the sleep control cycle is tied up with mood and mood disorders.

It was reported in an article by the Journal Sleep, that children with both insomnia and hypersomnia are more likely to be depressed, to be depressed for longer periods of time, and to experience additional problems such as weight loss. Especially at risk of depression and suicide are teens who don’t get enough sleep.

Depression makes achieving quality sleep difficult, and it leads to serious sleep issues and even disorders. The following are some of these sleep disorders.

Insomnia

The description of insomnia is difficulty falling or staying asleep. It is a fairly common problem for Americans. One in three people in the US experience insomnia at some point in their lives.

Why insomnia can lead to depression is easy to imagine. Lying awake at night, unable to sleep and unpleasant thoughts running around in your head is obviously extremely frustrating. Also, as a result, the excessive daytime sleepiness the following day reduces their general quality of life.

Sadly, 83% of depressed individuals display insomnia symptoms and they are ten times more likely to develop depression than people without.

What causes depression or sleep disorders is still not fully understood, but scientists have discovered that a neurochemical has links between the two. Corticotropin-releasing factor (CRF) is a neuropeptide and is found in elevated levels in people with depression and anxiety disorders. It also is found in high levels in many insomniacs. The hypothalamic-pituitary-adrenal (HPA) axis is stimulated perhaps excessively in both depressed people and insomniacs.

Hypersomnia

Basically the opposite of insomnia, hypersomnia is characterized by extreme oversleeping and still not feeling rested afterwards. Hypersomnia is found much more in younger adults with depression versus older ( 40% vs !0%). It is also much more common in women.

Changes in REM Sleep

The impact depression has on sleep is not just a coincidence. EEG tests of depressed patients show they spend less time in slow-wave sleep, shift to REM sleep earlier in the night, have a longer sleep latency and experience sleep maintenance insomnia, which is waking up during the night.

Researchers find the effects on REM sleep to be especially intriguing. REM (rapid eye movement) sleep abnormalities result in brain activity patterns similar to those seen in depression. During REM, parts of the brain exhibit similar electrical activity to that in depressed people, with their first REM session occurring earlier in the night. The worse the depression, the earlier the REM occurs.

In extreme cases the sequence of sleep stages is upset with the first REM period happening before the first deep sleep period. This is very harmful to growth hormone and body’s maintenance because the first deep sleep period is so important.

Scientists have also found that patients with major depressive disorder have high activity in the ventromedial prefrontal cortex (vmPFC) coupled with low activity in dorsolateral prefrontal cortex section of the brain. Scientists are working out the details, but this may provide a clue to why REM activity increases in depressed patients.

Sleep Apnea

Sleep apnea is a condition where a person literally stops breathing momentarily while sleeping. When the brain kicks in to start breathing again, it interrupts the sleep cycle, so even if the person does not wake up, it can still lead to sleep deprivation.

People with apnea are more likely to suffer from depression. Even snorers, who do not have true sleep apnea, are more likely to be depressed. Men are much more likely to experience this than women.

A study of nearly 19,000 people found that people with depression were over five times more likely to have obstructive sleep apnea or another form of sleep-disordered breathing.

Restless Leg Syndrome

Another comorbid (co-occurring) sleep disorder that occurs with depression is restless legs syndrome (RLS). Individuals with RLS feel an intense “pins and needles” sensation in their lower limbs when they lie down (as one does when they fall asleep). Jerking the limbs is the only way sufferers can relieve RLS. This obviously makes sleeping more difficult, contributing to insomnia along with depression.

What Is the Treatment for Sleep Disorders Related to Depression?

One thing for sure is getting good sleep is absolutely essential to overcome depression. Treating either depression or related sleep problems tends to improve the symptoms of the other.

There are some studies out there that claim sleep deprivation can actually cure depression. Researchers have indeed found that a night of sleep deprivation reduces symptoms of depression the following day. A rebound effect, (known as “residual insomnia”) however, can occur the following day. In addition, sleep deprivation is just impractical and dangerous on a long term basis because of the serious side effects on your mental, physical, and emotional health.

Read our reviews of some of the best mattresses for certain sleep disorders and pick one that could help you deal with your sleep problems.

The following are the recommended treatments for depression with psychotherapy being the most popular.

Psychotherapy

CBT, cognitive behavioral therapy, is the most popular form psychotherapy. CBT focuses on helping the individual recognize the negative or destructive thoughts (the cognitive aspect) that make them feel depressed, and the behaviors they’ve become accustomed to responding with. These thoughts and behaviors, once recognized by the person, can be changed by new ways of thinking or responding.

CBT-I, a sub-type of CBT, applies the same techniques to curing insomnia.

Pharmacology

Both depression and insomnia can be addressed with antidepressants, however, they can also be treated without drugs. The most common antidepressant medications are SSRIs (selective serotonin reuptake inhibitors). Most people who begin taking one of these medications will find relief for their sleep problems.

A stimulant is usually the pharmacological treatment for hypersomnia. These medications work opposite of sleeping pills. That’s why it is important for doctors to evaluate whether long-sleeping patients might have depression and be a better candidate for anti-depressant medication.

CPAP Therapy

Continuous positive airway devices (CPAP) are extremely effective for Individuals suffering from obstructive sleep apnea (OSA), insomnia and related depression. Individuals have to be fitted for these continuous positive airway pressure (CPAP) devices. People with co-morbid depression showed significant improvement a year after using their device.

OSA and depression can worsen if the individual is taking tricyclic antidepressants since sedatives can worsen the symptoms. Check with your doctors first and be sure to let them know about your OSA.

Click here for more tips for better sleep with depression.